A patient with a severe head injury develops hypertension, bradycardia, and irregular respiration. This triad indicates:
- A Neurogenic shock from high cervical cord injury
- B Raised intracranial pressure with impending herniation ✓
- C Haemorrhagic shock from occult intra-abdominal bleeding
- D Spinal cord transection below T6
Correct answer: B. Raised intracranial pressure with impending herniation
Explanation
The Cushing reflex, comprising hypertension (with widened pulse pressure), bradycardia, and irregular respiration, is a response to critically raised intracranial pressure. The medullary vasomotor centre triggers systemic vasoconstriction to maintain cerebral perfusion, and baroreceptors then produce reflex bradycardia. Neurogenic shock produces the opposite pattern, hypotension with bradycardia, which distinguishes it reliably from this triad.
Reference: Ganong's Review of Medical Physiology, 26th ed.
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